Systemic Disease Activity And Ocular Complications In Polyautoimmune Disease And Multiple Autoimmune Syndrome

Multiple autoimmune syndrome (MAS) or patients with at least three autoimmune diseases is often associated with more severe systemic disease activity and ocular surface inflammation. We aim to present the relationship between autoimmune disease activity and the severity of ocular surface damage in MAS.

Regional teaching hospital

We conducted a retrospective cross-sectional study with the intra-hospital database from 2011 to 2021. Patients with diagnostic codes and corresponding positive serology for Sjogren’s syndrome (SS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and their combinations were enrolled. Enrollees were divided into five groups: Primary SS, SS+RA, SS+SLE, RA+SLE, and RA+SS+SLE (MAS). Each group was subdivided into those with or without dry eye disease (DED). Laboratory profile and medications use were compared between MAS and the other groups.

 A total of 139 polyautoimmunity patients, including 11 MAS, were included. All MAS patients presented with DED and corneal complications. The incidence of DED and corneal complications in MAS was significantly higher than the other groups (All p < 0.05, except DED incidence in RA+SLE). As for laboratory data, ESR was higher in MAS compared to the other groups. Topical medications were more frequently prescribed in MAS compared to the other groups (All p < 0.01).

 MAS commonly presented with ocular surface complications, with more topical medication use. ESR may be a useful indicator of systemic disease activity or the severity of ocular surface damage in MAS. Rheumatologists should refer MAS patients to ophthalmologists to prevent severe corneal complications.